Awareness of Iranian Medical Sciences Students Towards Basic Life Support; a Cross-Sectional study

Introduction: Augmentation of the number of trained basic life support (BLS) providers can remarkably reduce the number of cardiac arrest victims. The aim of this study was to evaluate the level of BLS awareness among students of medical sciences in Iran. Methods: This multicenter cross-sectional study was performed on medical students at the 4 major medical schools in Tehran, the capital of Iran, between Jan 2018 and Feb 2019, using convenience sampling method. The level of medical sciences students’ awareness of BLS was measured using an international questionnaire. Results: Finally, 1210 students with the mean age of 21.2 ± 2.3 years completed the survey (79% female). 133 (10.9%) students had CPR experience and none had received any formal training. None of the responders could answer all questions correctly. The mean awareness score of participants was 11.93 ± 2.87 (range: 10.13 -17.25). The awareness score of participants was high in 49 (4.04 %) participants, moderate in 218 (18.01%), and low in 943 (77.93%) of studied cases. Conclusion: Based on the findings of this study, more than 70% of the studied medical sciences students obtained a low score on BLS awareness.


Introduction
Cardiac arrest is a fatal condition responsible for a large number of deaths in the modern world, and it has remained common worldwide (1)(2)(3). Deaths caused by cardiac arrest can be prevented via simple maneuvers and skills most of the time (5). Cardio-pulmonary resuscitation (CPR) is a life-saving and valuable technique that was invented back in 1960 (6); it is indeed a facile procedure that permits almost everyone to sustain life and decreases mortality up to 50% in golden minutes after cardiac and respiratory arrests (7,8).
Based on the place in which a cardiac arrest takes place, it is divided into two categories of out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). OHCA occurs approximately in 19-104 per 100,000 persons each year (0.019-0.104%), and 10% of them are said to be saved at the hospital (9). Statics present that 350,000 people in Europe die annually because of OHCA (9). In the USA, OHCA is responsible for 760,000 deaths per year (10). Augmentation of the number of trained basic life support (BLS) providers can remarkably reduce the number of cardiac arrest victims (16). Therefore, many countries worldwide have integrated these topics into the curricula of their educational centers or even workplaces believing that any individual in the society should have sufficient knowledge and awareness to provide BLS when needed (18). Having this in mind, expectation from physicians and paramedical staff is naturally higher as their career requires this knowledge. This study aimed to evaluate the level of BLS awareness among Iranian medical sciences students studying in four major Iranian medical schools.

Study design and participants
This multicenter cross-sectional study was performed on medical students studying in the 4 major medical schools (Tehran Medical Sciences of Islamic Azad University, Tehran University of Medical Sciences, Shahid Beheshti University of Medical Sciences, and Iran University of Medical Sciences) in Tehran, the capital of Iran, between Jan 2018 and Feb 2019, using convenience sampling method. The level of medical sciences students' awareness of BLS was measured using an international questionnaire. The study protocol was approved by Ethics committee of Iran University of Medical Sciences (IR.IUMS.REC.1399.1291).

Participants
Being a student in one of the fields of medical sciences (medicine, nursing, and midwifery) was the inclusion criterion. There was not any sex or age limitation in this study. Incomplete questionnaires were excluded (29 questionnaire).

Data gathering
Demographic data, age, CPR experience, sex, educational status, and attendance of BLS courses were collected using a checklist. In addition, an international questionnaire that measures the level of awareness about BLS was used for evaluating the awareness level of participants regarding BLS. We used the Persian version of the international questionnaire measuring the awareness of participants regarding BLS. This questionnaire was designed by ÖzbilginŞ et.al. based on the latest version of AHA guideline. The international questionnaire measuring awareness of BLS has 20 multiple-choice questions and each question has 1 point (19). The range of scores of this questionnaire is 16-20 (high), 11-15 (moderate), and 0-10 (Low). Persian version of this questionnaire is validated by Ziabari et al. 2019 (6).

Statistical analysis
A required sample size of 1210 participants, was calculated using Rao soft software. For statistical analysis, SPSS software version 22 (SPSS Inc. Chicago, IL, United States) was used. The findings were presented as mean ± standard deviation or frequency and percentage.

Results
Finally, 1210 students with the mean age of 21.2 ± 2.3 years completed the survey (79% female). Baseline characteristics of studied participants are presented in table 1. Among the participants, 133 (10.9%) had CPR experience and none had received any formal training. Table 2 shows the results of students' responses to 20 questions regarding BLS awareness. None of the responders could answer all questions correctly. The mean awareness score of participants was 11.93 ± 2.87 (range: 10.13 -17.25). The awareness score of participants was high in 49 (4.04 %) participants, moderate in 218 (18.01%), and low in 943 (77.93%) of studied cases.

Discussion
Based on the findings of this study, more than 70% of the studied medical sciences students obtained a low score on BLS awareness. Nowadays, with the growth of cardiopulmonary diseases, the rate of cardiac arrest has been remarkably increasing (3)(4)(5)(6). It is expected from a majority of community members to be efficiently aware of BLS (especially CPR) (7). CPR is one of the essential skills that people of a society have to learn because it is a life-saving skill and can reduce the number of OHCA victims (8). Based on the reports, performing proper basic life support can reduce the mortality rate, especially in OHCA (3-5, 7, 9). The Findings in this cross-sectional study showed low awareness of BLS among medical sciences students. About 90% of cases had no experience of CPR, and more than 95% of participants had no idea about safety, and they did not know what they have to do when someone lies unresponsive on the street. Many people do not like to give mouth-to-mouth

Limitations
Our study has some limitations. One of them is that it was conducted only in the four Medical Universities in Tehran and did not involve the whole country. This study only demonstrates and evaluates the awareness, and the knowledge and practice regarding BLS was not evaluated in this study. The number of students who completed the survey is not enough to generalize the results to other medical schools in Iran.

Conclusion
Based on the findings of this study, more than 70% of the studied medical sciences students obtained a low score on BLS awareness.

Author contribution
All authors made substantial contributions, revised the manuscript, and approved the final version for publication.

Funding sources
The author(s) received no financial support for the research, authorship, and/or publication of this article.

Conflict of interest
None to Declare.